Chun-Jen Huang

Prevalence and incidence of anxiety disorders in diabetic patients: a national population-based cohort study

OBJECTIVE This study aimed to investigate the prevalence and incidence of anxiety disorders among diabetic patients in Taiwan. METHODS Study subjects were identified by at least one service claim for ambulatory or inpatient care with a principal diagnosis of anxiety disorders and at least two service claims for ambulatory care or one service claim for inpatient care with a principal diagnosis of diabetes from 2000 to 2004 in the National Health Insurance database. RESULTS The 1-year prevalence rate of anxiety disorders among diabetic patients was 128.76 per 1000 in 2000, and the cumulative prevalence increased to 289.89 per 1000 in 2004. Diabetic patients had a higher cumulative prevalence and annual incidence than the general population throughout the observation period. A higher prevalence was associated with age (≥65, 55-64), female sex and low income by multiple logistic regression analysis. Cox regression analysis revealed that a higher incidence was associated with female sex and low income. CONCLUSIONS The prevalence and annual incidence density of anxiety disorders in diabetic patients were significantly higher than in patients with mental illness only in the general population. Female diabetic patients had a higher prevalence and incidence density of anxiety disorders. Anxiety disorders in diabetic patients were more prevalent in elderly women and in those with low income.

Prevalence and incidence of diagnosed depression disorders in patients with diabetes: a national population-based cohort study.

OBJECTIVE This study aimed to investigate the prevalence and incidence of diagnosed depression disorders among patients with diabetes in Taiwan. METHODS Study subjects were identified by at least one service claim for ambulatory or inpatient care with a principal diagnosis of depression disorder, and at least two service claims for ambulatory care or one service claim for inpatient care with a principal diagnosis of diabetes from 2000 to 2004, as found in the National Health Insurance database. RESULTS The 1-year prevalence of diagnosed depression disorders in the general population was 11.22 per 1000 in 2000, while the 5-year cumulative diagnosed prevalence increased to 40.76 per 1000 in 2004. The 1-year prevalence rate of diagnosed depression disorders among patients with diabetes was 33.95 per 1000 in 2000, and the 5-year cumulative prevalence increased to 92.17 per 1000 in 2004. Patients with diabetes had a higher 5-year cumulative prevalence and annual incidence than the general population throughout the observation period. A higher diagnosed prevalence was associated with a monthly income <US*

Prevalence and incidence of mental illness in diabetes: A national population-based cohort study

640 using multiple logistic regression analysis. Cox regression analysis revealed that a lower incidence was associated with male gender. CONCLUSIONS The prevalence and annual incidence density of diagnosed depression disorders in patients with diabetes were significantly higher than those in the general population. The prevalence of diagnosed depression disorder among patients with diabetes in Taiwan was lower than the rate in Western countries.

The association between participation in a pay-for-performance program and macrovascular complications in patients with type 2 diabetes in Taiwan: A nationwide population-based cohort study ☆

BACKGROUND This study aimed to investigate the prevalence and incidence of mental illness among diabetic patients in Taiwan. METHODS Study subjects were identified by at least one service claim for ambulatory or inpatient care with a principal diagnosis of mental illness, and at least two claims for ambulatory care or one claim for inpatient care with a principal diagnosis of diabetes from 2000 to 2004. RESULTS The one-year prevalence of mental illness among diabetic patients was 20.6% in 2000, and the cumulative prevalence increased to 42.2% in 2004. Diabetic patients had a higher cumulative prevalence and annual incidence than the general population throughout the observation period. A higher prevalence was associated with age ≥45 and low income, and a lower prevalence with male gender and residing in rural areas. Cox regression analysis revealed that a higher incidence was associated with female gender, age ≥45, and low income. CONCLUSIONS The prevalence and annual incidence density of mental illness in diabetic patients were significantly higher than in the general population. Females had higher prevalence and incidence density of mental illness among diabetic patients. Mental illness in diabetic patients was more prevalent in elderly females of low income, and less in rural areas.

Health care utilization and expenditures of persons with diabetes comorbid with anxiety disorder: a national population-based cohort study.

OBJECTIVE Diabetes and diabetes-related complications are major causes of morbidity and mortality worldwide and contribute substantially to health care costs. Proper care can prevent or delay vascular complications in people with type 2 diabetes. We sought to examine whether a diabetes pay-for-performance (P4P) program under Taiwans National Health Insurance program decreased risk of macrovascular complications in type 2 diabetes patients, and associated risk factors. RESEARCH DESIGN AND METHOD We conducted a longitudinal observational case and control cohort study using two nationwide population-based databases in Taiwan, 2007-2012. Type 2 diabetes patients with a primary diabetes diagnosis in year 2007 and 2008 were included. We excluded patients with any diabetes complications within 2years before the index date. A propensity score matching approach was used to determine comparable P4P and non-P4P groups. We followed each P4P and non-P4P patient until December 31, 2012. Complication incidence rates per 1000 person-years for each complication were calculated. RESULTS Overall, our results indicated that P4P patients had lower risk of macrovascular complications than non-P4P patients. Specifically, hazard ratios (95% confidence intervals) were 0.84 (0.80-0.88) for stroke, 0.83 (0.75-0.92) for myocardial infarction, 0.72 (0.60-0.85) for atrial fibrillation, 0.93 (0.87-0.98) for heart failure, 0.61 (0.50-0.73) for gangrene, and 0.83 (0.74-0.93) for ulcer of lower limbs. CONCLUSIONS Compared with patients not enrolled in the P4P program, P4P patients had lower risk of developing serious vascular complications. Our empirical findings provide evidence for the potential long-term benefit of P4P programs in reducing risks of macrovascular complications.

Major depressive disorder in patients with type 2 diabetes mellitus: Prevalence and clinical characteristics

OBJECTIVE The aim of this study was to investigate and compare health care utilization and expenditures between persons with diabetes comorbid with and without anxiety disorder in Taiwan. METHODS Health care utilization and expenditures among persons with diabetes with and without comorbid anxiety disorder in the period 2000-2004 were examined using the Taiwans National Health Insurance claims data. Health care utilization included outpatient visits and use of hospital inpatient services, while expenditures included outpatient, inpatient and total medical expenditures. General estimation equation (GEE) models were used to analyze the factors associated with outpatient visits and expenditures, and multiple logistic regression analysis was applied to identify factors associated with hospitalization. RESULTS In the study period, the average number of annual outpatient visits was 43.11-50.37 and 29.82-31.42 for persons with diabetes comorbid with anxiety disorder and for those without anxiety disorder, respectively. The average annual total expenditure was NT

Impact of Anxiety Disorders on Mortality for Persons With Diabetes: A National Population-Based Cohort Study

74,875-92,781 and NT

Prevalence of Depressive Disorder in Persons With Type 2 Diabetes: A National Population-Based Cohort Study 2000–2010

63,764-81,667, respectively. Controlling for covariates, the GEE models revealed that age and time were associated with outpatient visits. Income and time factor were associated with total expenditure. CONCLUSIONS Health care utilization and expenditures for persons with diabetes with comorbid anxiety disorder are significantly higher than those without anxiety disorder. The factors associated with health care utilization and expenditures are age, income and time.

Health Care Utilization and Expenditures of Patients with Diabetes Comorbid with Depression Disorder: A National Population-Based Cohort Study

BACKGROUND This study investigated the prevalence of major depressive disorder (MDD) among Taiwanese patients with type 2 diabetes mellitus (T2DM). METHODS We enrolled patients with at least one service claim for ambulatory or inpatient care with a principal diagnosis of MDD and at least two service claims for ambulatory care or one service claim for inpatient care with a principal diagnosis of T2DM, as listed in Taiwans National Health Insurance database. RESULTS We enrolled 715,756 people from the general population (GP), 61,589 patients with T2DM but without MDD, and 778 patients with both T2DM and MDD. The prevalence of MDD increased from 0.70% to 1.25% in the patients with T2DM, whereas it increased from 0.25% to 0.67% in the GP from 2000 to 2010. The higher prevalence of MDD was associated with the female sex, residing in the southern regions of Taiwan, and having comorbidities of cerebrovascular disease and anxiety disorder as well as higher comorbidity severity (Charlson comorbidity index, 1-2 and > 2). LIMITATIONS One limitation is the use of secondary data on diagnoses of MDD and T2DM. Another limitation is that we could not access some crucial related variables. CONCLUSIONS The prevalence of MDD was higher in the patients with T2DM than in the GP. In this study, the prevalence of MDD in the patients with T2DM was lower than that reported in Western countries.

Impact of non-apnea sleep disorders on diabetic control and metabolic outcome - A population-based cohort study

BACKGROUND Most studies of the relationship between psychiatric disorders and mortality in patients with diabetes mellitus (DM) have focused on the role of depression. OBJECTIVE The aim of this study was to investigate the impact of anxiety disorders (ADs) on mortality in persons with DM in Taiwan. METHODS We used Taiwan׳s National Health Insurance claims database interlinked externally with Taiwan׳s Death Registry to study mortality in diabetic patients with and without ADs during the study period 2000-2004. Five-year survival cures were calculated using the Kaplan-Meier method for DM with ADs and DM without ADs. Cox regression analysis was used to analyze the predictive factors for DM mortality. RESULTS We identified 5685 persons with DM, including 732 (12.88%) who also had ADs. The 5-year survival was longer for diabetic patients with ADs than those without it. A higher risk of mortality was found in diabetic patients who were male. It was also higher for those who were 45-64 years old and ≥65 years old, those who resided in rural areas, those who had incomes <US